Mastectomy or Lumpectomy: 10 Questions to Help You Decide

Weigh Your Options, Priorities and Emotions

If you have found out you have breast cancer, you may be trying to choose between a mastectomy or a lumpectomy. Many women with early-stage breast cancer are given the option to choose which surgery to have for breast cancer. But it’s not an easy decision, because it changes your life and your body forever. It is an intensely personal decision that only you can decide. Getting a handle on your feelings and priorities can help you make the decision. Here are some good questions to consider when considering a mastectomy or lumpectomy. 

1. How would you feel about losing your breast?

Medical Examination Radiography. Credit: Media for Medical / Contributor / Getty Images

For many women, regardless of breast size, breasts are an intrinsic part of their self-image and sexual identity. Having both breasts may be very important to your present intimate life or your future relationships. For other women, losing a breast and then having breast reconstruction or wearing a breast prosthesis is a good solutiona.

2. How might a mastectomy affect your sex life?

Couple in bed - 22.12.2010. Credit: Ullstein Bild / Contributor / Getty Images
For some women and their partners, the loss of a breast may not matter when your health concerns take center stage. But for other couples, losing one or both breasts may be a deal-breaker. Have a frank private discussion about this, before you decide on surgery.

3. Are you willing to have radiation treatments if you opt for a lumpectomy?

Radiotherapy. Credit: BSIP / Contributor / Getty Images

You may need to set aside six or more weeks for breast radiation after a lumpectomy. This will involve travel time, scheduling appointments and taking extra good care of your skin. You will need time off from a job, have childcare arranged and find dependable transportation.

4. Do you have local access to a radiation clinic?

Radiotherapy. Credit: BSIP / Contributor / Getty Images

If not, would you have to travel more than a reasonable distance for treatments? Some women are willing to stay in another town during their six weeks of radiation and some are unwilling or not able to afford that. How would you handle it?

5. Have you had previous chest radiation treatments?

Radiotherapy. Credit: BSIP / Contributor / Getty Images

If you have, you may have already had the maximum lifetime dose of radiation for your chest. Discuss this with your doctor to see if you would be a candidate for more radiation treatments. 

6. Are you willing to have more surgery after a mastectomy for reconstruction?

Plastic Surgery On A Breast. Credit: BSIP / Contributor / Getty Images

Most reconstruction methods will require more than one extra trip to the hospital to complete the new breast. Check with your health insurance provider to see what procedures they will cover for you.

7. How high is your anxiety about having a recurrence of breast cancer?

US-Politics-Health-Breast-Cancer. Credit: Chris Kleponis / Stringer / Getty Images

You may be able to live with any fear of cancer recurrences if you opt for a lumpectomy and radiation.However, if the thought of a recurrence frightens you, a mastectomy may help lower your fears.

8. Do you have a family history of breast or ovarian cancer?

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If so, your risk of recurrence may be high and this would influence your decision. Consider having a genetic test, to see if you carry the genetic mutation on BRCA1 or BRCA2 then see a genetic counselor to discuss your test results. Knowing your genetic predisposition may help you decide which procedure would work best for you.

If you have a family history of breast cancer or know that someone in the family has the genetic mutation on BRCA1 or BRCA2, that may also affect your choice of lumpectomy or mastectomy.

9. Are you feeling aggressive toward your tumor?

Mammotome. Credit: BSIP / Contributor / Getty Images

If so, you may want to get rid of all possible cancer as soon as possible and deal with other issues later. Depending on the size of your tumor relative to the size of your breast, a mastectomy or a lumpectomy may work for you.

10.What cosmetic results would you be content with after breast cancer surgery?

Plastic Surgery On A Breast. Credit: BSIP / Contributor / Getty Images

For some women, a lumpectomy is minimally invasive and only leaves a dimple in the breast. But for others, a lumpectomy may cause a change in size or a distortion of breast shape. You can use a partial prosthesis to compensate for the difference or you may choose to go natural. You might also choose to have your other breast reshaped to restore your symmetry. If you choose to have a mastectomy, you may also consider how to balance your appearance after surgery. Think about what options would appeal to you.

Take Time to Make Your Decision

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Research has shown that if you have these four things, early-stage breast cancer, only one tumor, a tumor less than four centimeters and clear surgical margins, then a lumpectomy and radiation will give you the same odds of survival as a mastectomy. However, this is your breast, your body image, your life and your feelings. If you are offered a choice between lumpectomy and mastectomy, make sure you take time to sort out your priorities and your emotions. Discuss your decision with your family and your doctor. Make a choice that you will feel confident and comfortable with. 


Plastic Surgery On Breast. Credit: BSIP / Contributor / Getty Images

Surgery for Breast Cancer. American Cancer Society. Last Revised: 05/13/2009.

Clinical practice guidelines for the care and treatment of breast cancer: 3. Mastectomy or lumpectomy? The choice of operation for clinical stages I and II breast cancer. Hugh Scarth, Jacques Cantin, Mark Levine, for the Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Canadian Medical Association Journal, 2002 update.

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